Provider Demographics
NPI:1437619988
Name:LEARY, MARJEAN DIANE (RN)
Entity Type:Individual
Prefix:
First Name:MARJEAN
Middle Name:DIANE
Last Name:LEARY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 NEW BRIGHTON ROAD
Mailing Address - Street 2:APT, SUITE, BLDG. (OPTIONAL)
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:612-968-0135
Mailing Address - Fax:
Practice Address - Street 1:338 NEW BRIGHTON ROAD
Practice Address - Street 2:APT, SUITE, BLDG. (OPTIONAL)
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112
Practice Address - Country:US
Practice Address - Phone:612-968-0135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR87853-3163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health